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Current Status on ICD 10 Implementation


What is the status on ICD-10? In this Infographic I bring you the facts you always wanted to know & 6 foundation blocks for successful ICD-10 implementation – PowerPoint PPT presentation

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Title: Current Status on ICD 10 Implementation

Current Status on ICD-10 Implementation
Presented By Victoria, thepracticebridge
  • We will be using ICD-10 another 19 days. Before
    that I will make you to walk through the status
    on ICD-10 implementation.

I have few questions in my mind
  • Does the claims errors will Increase?
  • Will A/R could rise?
  • Will there be a rise in claim denial rates?

  • 2015 survey was intended only for healthcare
    providers. 60 responded on behalf of a hospital
    or health system. Hope we will get more
    clarifications if we go through the survey.

  • According to the survey, just 7 of physicians
    said they have started transitioning to ICD-10
  • 31 of respondents said they had not started the
    transition at all.
  • Among solo physicians, 82 said they have not
    started the transition at all or have made only
  • 42 of respondents said they are "not at all
    confident" that the implementation of ICD-10 will
    cause no serious disruptions.
  • 83 of respondents expect the transition to
    result in delayed or denied claims
  • 36 expect to face disruptions that require them
    to draw from personal funds

  • 32 said they might reduce staff size, work hours
    or benefits and
  • 30 said they might retire early because of
    anticipated cash-flow issues related to the
  • 65 said they are capable of processing ICD-10
  • 52 said their practice management software was
    capable of processing ICD-10 codes
  • 1 said they will need to completely replace
    their IT systems to comply with ICD-10.

A recent survey of 1,100 organizations found
  • More than half of respondents were uncertain of
    the actual ICD-10 deadline.
  • And more than half had not yet completed
    end-to-end testing.
  • Some providers still believe the switch to
    ICD-10 isn't going to happen this year.

  • "This is an off-election year, and if I was a
    politician, I would roll ICD-10 out during an
    off-election year rather than delay it," says Mr.
    Joshua Berman, Relay Health ICD-10 Director.

  • Provider organizations that haven't adequately
    prepared for the switch are going to have issues
    with the processes that ICD-10 requires. However
    even organizations that have prepared may still
    have problems.

This isn't a technology change, it's a
process change
  • The switch to ICD-10 requires coding staff,
    physicians and all others who document conditions
    to be properly trained to ensure billing is done

  • All providers are likely to encounter some issues
    with the switch to ICD-10, including an increase
    in claim denials and the amount of time it takes
    payers to process claims

  • For small practices Road to 10 from CMS has
    primer for clinical documentation, clinical
    scenarios, and other specialty-specific resources
    to help with implementation.

  • Medicare claims processing systems will not have
    the capability to accept ICD-9 codes for dates of
    services after September 30, 2015

6 foundations for ICD-10 implementation you
cant ignore!
  • ICD-10 CM/PCS Communication
  • Coding Education
  • Clinical Documentation Initiatives
  • IT Plan
  • Revenue Cycle Plan
  • Post "Go Live" Health Information Management
    coding activities

  • Concise Messaging
  • Vision Statement
  • Partners Roles
  • Timelines
  • Defined Methods of Communication

ICD-10 CMS/PCS Vision Statement
  • Clarity-steering the team in the right direction
  • Inspiring and meaningful versus compliance driven
  • Expected outcomes-how we will be working
    differently following ICD-10 implementation

Partners and Roles
  • Identify
  • Internal groups
  • External groups (Partners)
  • Agreed upon communications

  • Have a timeline that outlines milestones,
    secondary tasks and deadlines keep implementation
    teams on task.
  • Multiple communication methods should be used
    Thumb of rule says, seven times, seven ways

Coding Education
  • Self assessment goals checklists
  • Rate your self on a scale 1(Goal not accomplished
    at all) to 5(Goal accomplished)
  • Are you aware of your foundational knowledge
    strengths related to AP, disease processes,
    pharmacology, etc.?
  • Are you completing tasks to improve your
    weaknesses related to AP, disease processes,
    pharmacology, etc.?

  • Are you networking with a subject matter expert
    and peers?
  • Are you practicing and applying codes to real
    world documentation?
  • Are you working to understand the ICD-10-CM/PCS
    coding guidelines?
  • Are you gaining a deeper understanding of the
    clinical documentation improvement protocols?
  • Do you work collaboratively with clinical
    documentation specialists when a clarification or
    query is needed?

Clinical Documentation Improvement
  • The success for this includes
  • physician involvement
  • communicating documentation gaps
  • Other key data findings
  • Which agree upon goals of a CDI improvement
    process and ongoing focused reviews with

  • Medical staff, CDI staff the coding staff will
    need education on the findings from documentation
  • Findings should include discussion of the
    documentation elements needed to support ICD-10
    codes through use of specific examples.
  • The value of more concise data capture for high
    quality data should be emphasized.

IT Block
  • For the most part, IT plans for the transition to
    ICD-10 are well underway, due in part to the
    conversion to 5010 compliance.
  • Important elements of the IT building block for
    ICD-10 readiness to be monitored throughout the
    implementation include.

  • Communications to and from vendors
  • Testing of system capabilities
  • The costs associated with IT implementations
  • Necessary upgrades and system maintenance.
  • Decisions around how ICD-9 and ICD-10 databases
    will be accessed and maintained will need to be

Revenue Cycle Block
  • The 9 pieces of advice from Government Health IT
    practices must consider
  • Practices should develop a budget and strategy to
    provide for additional cash reserves should
    delays in payment occur.
  • Practices should conduct financial modeling to
    understand the impacts of moving from ICD 9 to
    ICD 10 the impacts should be looked at by
    provider, by facility, by service line, and by
    geography if applicable.

  • The potential for backlogs in medical Coding,
    billing, and claim edits should be analyzed and a
    strategy developed to work the backlogs.
  • A strategy for pre and post ICD 10 denials
    management should be developed.
  • Assess the readiness of external vendors who
    support coding, billing, follow up and denials.
  • Any audits currently performed (compliance, RAC,
    etc.) should be reviewed to determine ICD 10

  • Managed care contracts should be reviewed and if
    necessary, renegotiated to decrease negative
    impacts to the bottom line.
  • The readiness of high volume payers should be
    assessed to determine their ability to process
    claims. Many payers are now posting readiness
    information on their web sites.
  • Conduct CDI reviews using ICD 10 code sets to
    determine if documentation contains the
    specificity necessary for ICD 10.

Post Go Live HIM/Coding Activities.
  • Most important block for ICD-10 implementation is
    to plan the activities to undertake following the
    deadline. As Sir Walter Scott said, I can give
    you a six-word formula for success Think things
    through then follow through

  • Practices must follow through and monitor coding
    accuracy and productivity following go live.
  • When problems are identified, strategies should
    be implemented to address workflow problems,
    process problems, and resource issues.
  • Determine if further education and training is
    needed and provide it expeditiously to prevent
    future issues.

  • Monitor for opportunities to improve data
    integrity through EHR enhancements, monitoring of
    alerts, and communication with physicians
    clinical documentation improvement staff.
  • Finally, monitor productivity to manage
    responding to staffing needs.
  • Go live will be a challenging time for all and
    retention of highly trained, skilled coding staff
    will be essential.

  • Which of these building blocks needs more
    attention in your organization? Which has been

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